Your Treatment: Making a Commitment

Sticking to your cholesterol treatment is one of the most important commitments you can make to your health. We interviewed Dr. Peter Lin, family physician and Director of the Primary Care Initiative at the Canadian Heart Research Centre, to find out why staying with your treatment is so important, and how to make it easier.

Sticking to treatment: Why it can be hard

Cholesterol treatment often includes a combination of medication plus diet changes and exercise. If you're having trouble sticking to your treatment, you're not alone. According to Dr. Peter Lin, family physician and Director of the Primary Care Initiative at the Canadian Heart Research Centre, non-adherence (not taking your treatment as recommended by your doctor) is very common – it can affect up to three-quarters of people with high cholesterol.

Why are so few people sticking to their treatment? Dr. Lin says there are many different reasons. The first is that people think cholesterol is "just a number." Because they don't feel it, it doesn't bother them. They're often not aware that high cholesterol is linked to heart attacks and strokes.

Dr. Lin also finds that many people don't stick to their treatment because of concerns about side effects. News reports of cholesterol pills causing muscle-related side effects have caused people to worry about whether their own medication could cause a similar problem. However, Health Canada (the government agency responsible for medication approval and safety in Canada) has examined the safety of cholesterol medications. The medication that had a higher risk of muscle problems was removed from the market so it is no longer sold. For the remaining medications of the same type, this side effect is very rare.

According to Dr. Lin, information is another factor that comes into play. Doctor's visits are often quite short. People may not be sure what questions to ask during the visit or they may feel overwhelmed or intimidated during the visit. As a result, they may not have the information they need to make a fully informed decision about the risks and benefits of the medication. To learn more about what you need to ask your doctor, see "Talking to your doctor."

These are some of the main reasons people don't stick to their treatment. Other people may have different reasons, such as difficulty remembering the medication, forgetting to refill it, or being "too busy" to make certain lifestyle adjustments, such as changing your diet or getting more exercise. Whatever the reason, there are ways to cope. See "What you can do to stick to your treatment" to learn more.

How staying with treatment can help you

According to Dr. Peter Lin, family physician and Director of the Primary Care Initiative at the Canadian Heart Research Centre, there is a great deal of evidence to support high cholesterol treatment. More than 40 years' worth of studies have shown that treating high cholesterol can help reduce the risk of heart attack, stroke, and circulation problems.

Left untreated, high cholesterol builds up in your arteries, forming a plaque. The plaque grows and often ruptures, causing a blood clot that can block the blood vessels. A blocked blood vessel in the brain can cause a stroke, and a blocked blood vessel in the heart can cause a heart attack. Even before it ruptures, a plaque can narrow the blood vessels, which could lead to circulation problems.

Treating high cholesterol can change the course of the disease and reduce the risk of heart disease, stroke, and circulation problems. Plus, Dr. Lin says, more aggressive treatment of cholesterol can lead to better results. A recent study suggests that we can not only slow down the formation of plaques in the blood vessels, but actually reverse it if we get cholesterol levels low enough. The study found that if you lower cholesterol enough you can actually shrink existing plaques. So if you stick with your treatment, you can not only stop new damage – you may also be able to reverse some of the damage that has already been done. The better you stick to your treatment, the better your results will be.

In fact, taking your medication consistently could even help you live longer. A recent study in the Journal of the American Medical Association looked at people with high cholesterol who were using a type of cholesterol medication known as statins. They found that people who took their medication regularly (at least 80% of the time) were much more likely to survive than those who didn't (i.e., those who took their medication less than 80% of the time), and this wasn't just because people who take their medication regularly also tend to live a healthier lifestyle.

Often, people have good intentions about taking their medication, but things get in the way. To learn more about what you can do to overcome these barriers, see "What you can do to stick with your treatment."

What you can do to stick with your treatment

Most people do not take their cholesterol treatment as recommended by their doctor. According to Dr. Peter Lin, family physician and Director of the Primary Care Initiative at the Canadian Heart Research Centre, it's important to examine the reasons why you may not be taking your treatment. Then you can find ways to cope with these issues. Here are some suggestions.

Putting side effects into perspective

Concern about side effects is a common reason people don't use their treatment. Dr. Lin has found that people tend to overestimate the risk of side effects. It's important to put side effects into perspective. For example, although the side effect of muscle damage with cholesterol-lowering medications has been in the news, it's actually quite rare: according to Dr. Lin it affects only about 1 in every 25,000 people. Talk to your doctor about which side effects you may expect, how likely they are (in real numbers) and what you should do if they occur.

Making the benefits real to you

Often, people don't stick with their cholesterol treatment because the benefits just don't seem real to them. Cholesterol seems like "just a number" that you can't see or feel. But it's much more than this – lowering your cholesterol can dramatically reduce your risk of stroke and heart attack and help you live longer. To help make this more real to you, Dr. Lin suggests:

Print out a picture of an artery with cholesterol build-up or a heart damaged by clogged arteries (such as the warning picture seen on some cigarette packages) and another artery that's clear and healthy so you can see how your treatment is helping behind the scenes.

Ask your doctor about your cholesterol treatment targets, and get copies of your blood tests to see if you're getting closer to your targets.

Think of your blood vessels as a car, and your cholesterol treatment as a special rust-proofer that not only prevents rust from building up but, if used right, can also repair some existing rust damage. You need to apply the rust-proofer regularly for it to work properly, but if you do, your car will stay rust-free.

Dealing with other issues

If you tend to forget to refill your medication, ask your pharmacy about automated refills or email reminders to fill your prescription.

If you tend to forget to take your medication, try to get into a routine where you take it at the same time each day, put the medication somewhere it is easy to see, leave yourself reminders (such as sticky notes or an alarm), and coordinate taking your medication with other activities you do each day.

If you're having problems finding time to exercise, try exercising in periods of at least 10 minutes each instead of trying to block off 30 to 60 minutes all at once.

If you're not sure how to change your diet, talk to a registered dietitian; they can help steer you in the right direction about your diet.

Remember that although diet and exercise can help control cholesterol, some people's bodies make a lot of cholesterol and they need medication in addition to diet and exercise in order to get cholesterol down to a healthy level.

Talking to your doctor

It's hard to make a real commitment to your treatment unless you fully understand how it will help and what the risks may be. People may stop taking a medication that is helping them or stop eating a healthier diet because they don't understand all the risks and benefits of treatment. Your doctor can provide you with this information – here are a few questions to ask:

What is the benefit of using this treatment?

How much will this treatment reduce my risk of heart attack and stroke? (ask for specific numbers)

What are the main risks of this treatment?

How likely are these treatment risks? (ask for specific numbers)

Your doctor can give you a realistic idea of the benefits and risks of your treatment, so you can make an informed decision. Your doctor can also help you take control of your treatment by helping you learn more about what to expect from your treatment and what you should do if side effects occur.

Taking control of your treatment:

When can I expect results from my treatment?

How will I know that my treatment is working?

What side effects should I be looking for (this doesn't only apply to medication users), and what should I do if they happen? (Ask your doctor to be specific about exactly what you should do, such as "stop taking the medication", "get immediate medical attention," or "make an appointment with your doctor next week")

When should I come back to have my cholesterol checked?

What target levels of cholesterol should I be aiming for? What are my levels now?

What changes should I be making in my lifestyle (e.g., diet, exercise) to help get my cholesterol to healthy levels?

Talking to your doctor can help you make an informed decision about cholesterol treatment, and take control of the treatment plan that you and your doctor choose. If you're not sure of the answers to any of the questions above, make an appointment to see your doctor about your cholesterol treatment!